Evidence map›Paper›PMID 32087176›Full record

ArticleThe Lancet. Global health2020

Effects and cost of different strategies to eliminate hepatitis C virus transmission in Pakistan: a modelling analysis.

Aaron G Lim, Josephine G Walker, Nyashadzaishe Mafirakureva, Gul Ghuttai Khalid, Huma Qureshi, Hassan Mahmood, Adam Trickey, Hannah Fraser, Khawar Aslam, Gregoire Falq and 16 more

2 registry-linked trialsOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 22 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 3 pooled it
3.3field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04943588 completednot on this mapstarted 2021, after this paper: background citation

Treating Hepatitis C in Pakistan. Strategies to Avoid Resistance to Antiviral Drugs

Typeobservational_patient_registrySponsorQueen Mary University of LondonRan2021 to 2026Enrolled25,000ConditionsHepatitis C, ChronicArmsHCV RNA (PCR), HCV Antibody test (Point of care), AST/ALT and platelets measurement
NCT05248919 naenrolling by invitationnot on this mapstarted 2023, after this paper: background citation

Therapy for Hepatitis C Virus (HCV) in Primary Treatment Failure in Pakistan

TypeinterventionalSponsorQueen Mary University of LondonRan2023 to 2027Enrolled318ConditionsHepatitis CArmsEpclusa (nucleotide HCV NS5B polymerase inhibitors).
3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 39 citations in OpenAlex.

  1. Pooled it
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  3. Pooled it
  4. Article
  5. Hepatitis C Screening: A Health Technology Assessment.Ontario health technology assessment series · 2026
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  7. Review
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  14. Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2023
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors at 8 institutions in 5 countries.

Aaron G LimPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Electronic address: aaron.lim@bristol.ac.uk.
Josephine G WalkerPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Nyashadzaishe MafirakurevaPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Gul Ghuttai KhalidMédecins Sans Frontières, Brussels, Belgium.
Huma QureshiDoctors Plaza, Karachi, Pakistan.
Hassan MahmoodPakistan Health Research Council, Islamabad, Pakistan; WHO, Islamabad, Pakistan.
Adam TrickeyPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Hannah FraserPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Khawar AslamMédecins Sans Frontières, Brussels, Belgium.
Gregoire FalqEpicentre, Médecins Sans Frontières, Paris, France.
Camille FortasPasteur Institute, Paris, France.
Hassaan ZahidMédecins Sans Frontières, Brussels, Belgium.
Ammara NaveedDepartment of Gastroenterology and Hepatology, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan.
Rosa AuatMédecins Sans Frontières, Brussels, Belgium.
Quaid SaeedNational AIDS Control Programme, Islamabad, Pakistan.
Charlotte F DaviesPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Christinah MukandavireDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK.
Nancy GlassDivision of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
David MamanEpicentre, Médecins Sans Frontières, Paris, France.
Natasha K MartinPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, CA, USA.
Matthew HickmanPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Margaret T MayPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Saeed HamidAga Khan University, Karachi, Pakistan.
Anne LoarecEpicentre, Médecins Sans Frontières, Paris, France.
Francisco AverhoffDivision of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Peter VickermanPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
University of Bristol · GBMédecins Sans Frontières · BEMédecins Sans Frontières · FRCenters for Disease Control and Prevention · USAga Khan University · PKImperial College London · GBInstitut Pasteur · FRPakistan Health Research Council · PK

Funding

UC San Diego Clinical and Translational Research InstituteUL1TR001442 · NCATS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI FIRESTEIN, GARY S, HOGARTH, MICHAEL · 2015 to 2024
$88.3M
VirologyP30AI036214 · NIAID · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI SUSAN JANET LITTLE · 1994 to 2026
$78.4M
Optimizing HIV prevention portfolios targeting people who inject drugs using dynamic economic modelingR01AI147490 · NIAID · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MARTIN, NATASHA · 2019 to 2022
$2.3M
Department of Health RP-DG-0610-10055Department of Health RP-PG-0616-20008Medical Research Council MR/N00616X/1NCATS NIH HHS UL1 TR001442NIAID NIH HHS P30 AI036214NIAID NIH HHS R01 AI147490
6 · The paper itself

Abstract

backgroundThe WHO elimination strategy for hepatitis C virus advocates scaling up screening and treatment to reduce global hepatitis C incidence by 80% by 2030, but little is known about how this reduction could be achieved and the costs of doing so. We aimed to evaluate the effects and cost of different strategies to scale up screening and treatment of hepatitis C in Pakistan and determine what is required to meet WHO elimination targets for incidence.

methodsWe adapted a previous model of hepatitis C virus transmission, treatment, and disease progression for Pakistan, calibrating using available data to incorporate a detailed cascade of care for hepatitis C with cost data on diagnostics and hepatitis C treatment. We modelled the effect on various outcomes and costs of alternative scenarios for scaling up screening and hepatitis C treatment in 2018-30. We calibrated the model to country-level demographic data for 1960-2015 (including population growth) and to hepatitis C seroprevalence data from a national survey in 2007-08, surveys among people who inject drugs (PWID), and hepatitis C seroprevalence trends among blood donors. The cascade of care in our model begins with diagnosis of hepatitis C infection through antibody screening and RNA confirmation. Diagnosed individuals are then referred to care and started on treatment, which can result in a sustained virological response (effective cure). We report the median and 95% uncertainty interval (UI) from 1151 modelled runs.

findingsOne-time screening of 90% of the 2018 population by 2030, with 80% referral to treatment, was projected to lead to 13·8 million (95% UI 13·4-14·1) individuals being screened and 350 000 (315 000-385 000) treatments started annually, decreasing hepatitis C incidence by 26·5% (22·5-30·7) over 2018-30. Prioritised screening of high prevalence groups (PWID and adults aged ≥30 years) and rescreening (annually for PWID, otherwise every 10 years) are likely to increase the number screened and treated by 46·8% and decrease incidence by 50·8% (95% UI 46·1-55·0). Decreasing hepatitis C incidence by 80% is estimated to require a doubling of the primary screening rate, increasing referral to 90%, rescreening the general population every 5 years, and re-engaging those lost to follow-up every 5 years. This approach could cost US$8·1 billion, reducing to $3·9 billion with lowest costs for diagnostic tests and drugs, including health-care savings, and implementing a simplified treatment algorithm.

interpretationPakistan will need to invest about 9·0% of its yearly health expenditure to enable sufficient scale up in screening and treatment to achieve the WHO hepatitis C elimination target of an 80% reduction in incidence by 2030.

fundingUNITAID.

Indexed as

AdultCost-Benefit AnalysisDisease EradicationGoalsHepatitis CHumansIncidenceMass ScreeningModels, TheoreticalPakistanSeroepidemiologic StudiesWorld Health Organization

Identifiers

PMID32087176
PMCPMC7295205
OpenAlexW3007685501

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.